Blood Transfusion is Associated with Increased Perioperative Morbidity and Adverse Oncologic Outcomes in Bladder Cancer .围手术期输血与增加膀胱癌患者的发病率和不良肿瘤结果接受新辅助.pdf

Ann Surg Oncol (2016) 23:2715–2722 DOI 10.1245/s10434-016-5193-4 ORIGINAL ARTICLE – UROLOGIC ONCOLOGY Blood Transfusion is Associated with Increased Perioperative Morbidity and Adverse Oncologic Outcomes in Bladder Cancer Patients Receiving Neoadjuvant Chemotherapy and Radical Cystectomy Heather J. Chalfin, Jen-Jane Liu, Nilay Gandhi, Zhaoyong Feng, Daniel Johnson, George J. Netto, Charles G. Drake, Noah M. Hahn, Mark P. Schoenberg, Bruce J. Trock, Andrew V. Scott, Steven M. Frank, and Trinity J. Bivalacqua James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD ABSTRACT p = 0.002), and morbidity (odds ratio [OR] 1.67, 95 % CI Purpose. Perioperative blood transfusion (PBT) has been 1.26–2.21; p = 0.004) in univariate analyses. In multi- inconsistently associated with adverse outcomes. Bladder variable models, PBT was significantly associated with cancer patients are unique as they frequently undergo morbidity (OR 1.77, 95 % CI 1.30–2.39; p = 0.0002), but neoadjuvant chemotherapy (NAC) with resulting not OS or CSS. Intraoperative transfusion was associated immunosuppression, which may be exacerbated by trans- with decreased OS and CSS, and increased morbidity, fusion-related immunomodulation. We examined the effect whereas postoperative transfusion was only associated with of leukoreduced PBT on oncologic outcomes and periop- increased morbidity. erative morbidity in radical cystectomy (RC) patients who Conclusions. Intraoperative blood transfusion was asso- received NAC, quantifying exposure with a novel dose- ciated with increased perioperative morbidity and index variable. worse